应用心肌分层应变及做功技术评估长期腹膜透析尿毒症患者左心室功能

［摘要］目的： 利用心肌分层应变及心肌做功技术对长期腹膜透析的尿毒症患者的左心室功能进行研究,评估其在长期腹膜透析下的心功能变化。方法: 选择长期规律进行腹膜透析且经常规超声心动图检查提示左心室射血分数(left ventricular ejection fraction,LVEF)正常的尿毒症患者14例,测量其常规二维超声心动图参数,利用二维斑点追踪及心肌分层应变技术测量左心室整体纵向收缩期峰值应变(global longitudinal peak systolic strain,GLS)及内膜层、肌层和心外膜层3层心肌的纵向收缩期峰值应变(longitudinal peak systolic strain,LS),并结合血压得出左心室心肌整体做功参数,共同评估左心室心肌功能,随访5年并比较腹膜透析5年前后相关数据变化。结果: 规律腹膜透析5年后,尿毒症患者LVEF改变无统计学差异;GLS在四腔心切面明显减低(P=0.018),并从心内膜减低至心外膜(LS心内膜层 P=0.029,LS肌层 P=0.017,LS心外膜层 P=0.004);心肌整体做功参数以整体无用功(GWW)升高为主(P=0.048),整体有用功(GCW)、整体做功指数(GWI)及整体做功效率(GWE)无统计学差异。结论: 长期规律腹膜透析5年的尿毒症患者,其左心室整体心肌功能尚保持稳定,但局部心肌收缩功能进一步受损,主要体现在后间隔和侧壁的各层心肌,心肌做功以GWW升高为主。     

胃泌素对大鼠胃粘膜环氧合酶及生长因子表达的影响

目的：探讨胃泌素对大鼠胃粘膜环氧合酶（COX）及生长因子表达的影响。方法：雄性SD大鼠皮下注射胃泌素1 μg/kg、10 μg/kg或100 μg/kg，Western blot和免疫组化检查胃粘膜COX-1、COX-2、肝细胞生长因子（HGF）和肝素结合表皮生长因子样生长因子（HB-EGF）表达。评价胃泌素受体拮抗剂YM022对COX-1、COX-2、HGF和HB-EGF表达的影响。结果：胃泌素剂量依赖性地增加大鼠胃粘膜COX-2和HB-EGF表达，而对COX-1和HGF表达无明显影响；YM022阻断胃泌素诱导的COX-2和HB-EGF表达。 结论： 胃泌素调节大鼠胃粘膜COX-2和HB-EGF蛋白表达，提示COX-2和HB-EGF参与与胃泌素相关联的胃粘膜增生和胃癌等的发病过程。     

Guidelines for the diagnosis,treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli

The dissemination of carbapenem-resistant Gram-negative bacilli (CRGNB) is a global public health issue. CRGNB isolates are usually extensively drug-resistant or pandrug-resistant, resulting in limited antimicrobial treatment options and high mortality. A multidisciplinary guideline development group covering clinical infectious diseases, clinical microbiology, clinical pharmacology, infection control, and guideline methodology experts jointly developed the present clinical practice guidelines based on best available scientific evidence to address the clinical issues regarding laboratory testing, antimicrobial therapy, and prevention of CRGNB infections. This guideline focuses on carbapenem-resistant Enterobacteriales (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB), and carbapenem-resistant Pseudomonas aeruginosa (CRPA). Sixteen clinical questions were proposed from the perspective of current clinical practice and translated into research questions using PICO (population, intervention, comparator, and outcomes) format to collect and synthesize relevant evidence to inform corresponding recommendations. The grading of recommendations, assessment, development and evaluation (GRADE) approach was used to evaluate the quality of evidence, benefit and risk profile of corresponding interventions and formulate recommendations or suggestions. Evidence extracted from systematic reviews and randomized controlled trials (RCTs) was considered preferentially for treatment-related clinical questions. Observational studies, non-controlled studies, and expert opinions were considered as supplementary evidence in the absence of RCTs. The strength of recommendations was classified as strong or conditional (weak). The evidence informing recommendations derives from studies worldwide, while the implementation suggestions combined the Chinese experience. The target audience of this guideline is clinician and related professionals involved in management of infectious diseases.     

先天性麻痹性斜视眼肌的形态学改变及临床意义

目的研究先天性麻痹性斜视眼肌的形态学改变。方法将先天性麻痹性斜视12例18眼按年龄不同分为三组，将术中切下的眼外肌制成光镜和电镜标本进行比较。结果三组先天性麻痹性斜视的眼外肌均有病理性改变。年龄越大、病程越长，其病理改变越明显。结论先天性麻痹性斜视应早期手术治疗，以免眼外肌病理改变加重，影响双眼视功能恢复。